Provider Demographics
NPI:1063674117
Name:ROBERTSON, JENNIFER LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:BLOOD
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1705 TWEED ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-1426
Mailing Address - Country:US
Mailing Address - Phone:301-922-4816
Mailing Address - Fax:
Practice Address - Street 1:50 W MONTGOMERY AVE
Practice Address - Street 2:SUITE 110 A
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4216
Practice Address - Country:US
Practice Address - Phone:301-251-8965
Practice Address - Fax:301-251-0136
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04544103TC0700X
VA0810003931103TC0700X
DCPSY1000492103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical